Summary
Summary NURS 4183 Exam 3 Review
- Course
- NURS 4183
- Institution
- Prairie View A&M State University
This is a comprehensive and detailed review on Exam 3 for NURS 4183.
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BURNSDamage to the skin integrity from an energy source
Energy Sources • HEAT (Thermal)
o MOST COMMON – Hot liquid, hot steam, fire, etc.
▪ With patients who have been in a fire, or a closed
structure = AIRWAY – Inhalation injury
▪ AT RISK FOR RESPIRATORY SYSTEM PROBLEMS
• CHEMICAL
o Toxic substances came into contact with the skin like
powders, gases, or certain foods
▪ With powders you must watch out for inhalation
injury as well with those patients
▪ Alkaline vs. Acidic sources
• Acidic are easier to treat
• Alkaline the skin is going to have trouble
neutralizing the alkalotic source.
• ELECTRICAL
o Electrical source, or current that has damaged the skin (can
affect not only the skin but the structures under the skin like
the muscle and bones) = Iceberg effect
▪ Muscle & Bone structures affected – can affect the
heart by causing dysrhythmia and bone fractures (like
the spine)
▪ When the muscle is affected myoglobin and
hemoglobin will be released into the blood and clog
up if too much, can collect in the kidneys and cause
acute tubular necrosis (tubular and kidneys are
clogged and causing acute renal failure)
• COLD
o Frost Bite
• RADIATION
o Sun (sunburns), cancer treatment (radiation therapy)
• FRICTION
o Abrasion to the skin like in a car accident there can be road
rash
o Carpet Burn
Factors for Burn • Depth of Burn
Severity o How DEEP did the burn go? Did it only affect the epidermis or
all the way to the bone?
▪ 1st Degree (Epidermis): Superficial
▪ 2nd Degree (Dermis): Partial thickness
• Superficial partial thickness
• Deep partial-thickness
▪ 3rd Degree: Full – thickness
, ▪ 4th Degree: Deep full – thickness
• % Of the total surface body area burned
o RULE OF NINES
• Age
o Children – are small and can’t handle damage to the skin
o Elderly – skin integrity is weaker, especially since they have a
lot of medical issues
• Medical History
o Diabetics for example already have compromised circulation,
so healing of the tissue will be a lot harder
o Heart failure, the heart is already weak and the shifting of
fluid is going to cause a lot of stress on the heart
• Location
o Face, head, neck = issue in the respiratory system
o Torso = full thickness burn can restrict breathing
o perineum = infection, keeping the wound free of infection
o Inhalation injury = can be more complicated
Layers of the Skin • EPIDERMIS
o Top skin layer that PROTECTS us from environmental hazards
and prevents infections
o
• DERMIS
o Thicker than the epidermis, which contains blood vessels,
nerve endings, sweat/oil glands, and cells that create new
skin
• HYPODERMIS/ Subcutaneous Tissue
o Contains fatty tissue, veins, arteries, & nerves.
o Insulates muscle, bones, and organs, and regulates body
temperature.
▪ Burn to this layer will cause problems in regulating
the body temperature. When caring for this kind of
patient, you want to make sure the room is warm at
least 85-100 degrees
st
Depth of Burn • 1 Degree (Epidermis)
o Superficial
▪ Affects the top layer of the skin (only the epidermis)
▪ Very red or pink, PAINFUL, warm to the touch, no
blisters, or scars left behind
▪ Brisk capillary refill
,• 2nd Degree (Dermis): Partial thickness
▪ Affects the epidermis and dermis& severity can vary
▪ Very PAINFUL, shiny & moist: red/pink blisters
present, scars left behind
▪ May need skin graft if deep partial-thickness
▪ Blanching still present
o Superficial partial thickness
o Deep partial-thickness
• 3rd Degree: Full–thickness
▪ Epidermis and dermis are DESTROYED along with the
hair follicles, sweat glands, and nerves.
▪ Extends into HYPODERMIS (subQ tissues)
▪ NOT PAINFUL or the pain is decreased
▪ Skin will NOT HEAL (need skin grafting)
▪ Can look black, yellow, and red along with appearing
matte/dry
▪ HARD area? ESCHAR!!!
• Burned, dead tissue&.LEATHERY
• Can impede circulation & breathing if
circumferential burn (note location!)
• ESCHAR MUST BE REMOVED FOR HEALING
TO OCCUR!!
• 4th Degree: Deep full – thickness
▪ WORST OF ALL!! ALL LAYERS DESTROYED!!
• Extends to muscles, ligaments and bones
▪ Appears black, charred w/ ESCHAR!!
▪ All sensation GONE!!
, ▪ Needs skin grafting
Burn Location • Respiratory
o Face, nose, mouth, neck and torso
o Burns in these areas can cause respiratory issues, and
inhalation injuries
• Trouble Healing? Due to poor blood supply
o Ears and nose
o Infection and disfigured
• Disability
o Eyes (vision can be gone)
o hands and feet (hard to heal and physical therapy needed)
• Compartment Syndrome
o Full-thickness, circumferential on extremities and torso
• Infection
o Perineum (due to elimination)
o Bottom (due to elimination)
• %TSBA
Inhalation injury • Damage to the respiratory system due to breathing in: smoke (carbon
monoxide) thermal; (heat), chemicals and etc.
o High cause of death in fires
o Upper and lower airways are involved
• Carboxyhemoglobin > 15% (if carbon monoxide poisoning is
occurring)
o Neuro changes, drowsiness, headache, nausea, dizzy, red
color to skin or lips
o Treatment is 100% of oxygen on a nonrebreather mask
• Inhalation injury can occur:
o Burned in an enclosed structure
o Burns on face (nose or mouth)
o Carbonaceous sputum
o Hair singeing (head and nose)
o Sooty nose or mouth
o Bright red lips
o Issues talking
o Confusion, anxiety
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